Management of Major Burn Patients From the Kaohsiung Gas Explosion Disaster──Kaohsiung Chang Gung Experiences

高雄氣爆嚴重燒燙傷病患處置──高雄長庚經驗

謝牧翰(Mu-Han Hsieh) ； 吳政君(Cheng-Chung Wu) ； 郭寶仁(Pao-Jen Kuo) ； 蔡岳儒(Yueh-Ju Tsai) ； 林克謙(Ko-Chien Lin) ； 黃仁穩(Ren-Wen Huang) ； 林燦勳(Tsan-Shiun Lin) ； 江原正(Yuan-Cheng Chiang) ； 陳添興(Tien-Hsing Chen) ； 楊家森(Johnson Chia-Shen Yang)

《臺灣整形外科醫學會雜誌》 25卷1期 (2016/03) Pp. 1-11

摘要

背景：民國103年8月1日凌晨，高雄市區地底瓦斯管線意外氣爆造成大量人數傷亡。本篇文章記錄這段期間，高雄長庚灼傷中心收治重症病患之分析，包括灼傷區域、灼傷深度、其他相關創傷、血液水份的監測、以及敷料和人工真皮的使用，此外病患受傷後心靈層面的影響及併發症，亦作了詳細的紀錄。目的：本文旨在分享本院灼傷中心遭遇大量傷患時所面臨的人力短缺，治療方式選擇，以及病患預後。材料及方法：民國103年8月1日到8月3日，高雄長庚灼傷中心共收治10位重症燒燙傷病患。呼吸道灼傷者緊急接受氣氣管管內插管，四肢因灼傷造成腔室症候群者視需要接受焦痂切開術。水分及輸液是依據Parkland formula給予。依照病人嚴重嚴重度，視情況使用血液動力監控器，並且依病人情況使用敷料及人工真皮。當病人一旦拔管可以溝通時，精神科諮詢則馬上介入。結果：所有病患皆存活，存活率100%。平均燒燙傷面積39.5%，燒傷面積20%-60%不等，7位病患(70%)必須緊急插管，4位於四肢觸處患有腔室症候群需要焦痂切開術以及血液動力監測器，1位患有急性呼吸窘迫症候群，平均插管7.1天，平均加護病房照顧30.1天，平均12.9天可下床行走，平均住院天數55.8天。7位(70%)患者須接受分層皮膚移植重建，2位(20%)須接受疤痕鬆解及全層皮膚移植手術。3位患者(30%)另有其他外傷包括顱骨破裂併氣腦症，骨折等等。8位患者(80%)後續被診斷精神相關疾患並接受抗憂鬱及抗焦慮藥物治療。平均追蹤達九個月。結論：這次不幸的災難給與予我們一個難得的機會同時處置大量灼傷重症病患，也凸顯了目前醫療系統的困境與不足，對於處理未來類似的灼傷重症病患是一個難能可貴的經驗。

並列摘要

Background: An unexpected underground explosion in downtown Kaohsiung resulted in massive casualties. For the patients admitted to the Kaohsiung Chang Gung Memorial Hospital (KCGMH) Burn Center, the burned surface area, wound depth, associated injuries, advanced hemodynamic monitoring, type of dressing and dermal substitute, and psychological sequelae after major trauma were recorded and analyzed. Materials and Methods: Ten major burn patients with 2nd- to 3rd-degree burns were admitted to the KCGMH Burn Intensive Care Unit (ICU) due to massive flame burns from August 1 to 3, 2014. Immediate intubation and escharotomy were performed due to inhalation injury and compartment syndrome, respectively. Resuscitation was performed based on the Parkland formula. Advanced hemodynamic monitoring was used on selected patients. Wound dressing and dermal substitutes were used as needed. Psychiatric consultations were available for patients once they were able to communicate. Results: All patients survived. The average burned surface area was 39.5% (range, 20-60%). Seven patients received immediate intubation. Four patients received immediate escharotomy and advanced hemodynamic monitoring. One patient developed acute respiratory distress syndrome. The average time of intubation and ICU stay were 7.1 days and 30.1 days, respectively. The average time to ambulation and hospital stay were 12.9 days and 55.8 days, respectively. Split-thickness skin graft was performed on 7 patients. Two patients received scar contracture release and full-thickness skin graft 4 months later. Associated injuries such as skull bone fracture with pneumocranium and bony fractures were observed in three patients. Eight patients were diagnosed with psychiatric disorders and received anxiolytic/anti-depressant medications. The mean follow-up period was 9 months. Conclusion: This unfortunate incident provided us with a rare opportunity to treat a large number of burn patients simultaneously. This unique experience is not only educational but also extremely valuable for the future treatment of major burn patients in batch. (J Taiwan Soc of Plast Surg 2016;25:1～11)

並列關鍵字

kaohsiung gas explosion ； major burn ； artificial dermis ； burn related depression